Optimizing Ventral Hernia Repairs With a Concomitant Panniculectomy: A Combined Approach Using Component Separation and Onlay Acellular Dermal Matrix.

Purpose: The use of a concomitant panniculectomy (PAN) during a ventral hernia repair (VHR) has been debated because of concerns of higher wound complications and longer operative times. However, PAN offers significant advantages including increased intraoperative exposure, improved patient quality of life, and offering an aesthetic benefit. In the treatment of large hernia defects the senior author utilizes the component separation technique with onlay placement of acellular dermal matrix (ADM). Additionally, the ADM is secured using progressive quilting suturing. This study aimed to evaluate the outcomes of patients who underwent VHR + PAN utilizing the component separation technique alongside onlay placement of ADM.

Methods: A single-center retrospective analysis was conducted on the senior author's technique in treating VHR + PAN over 10 years. The patients were identified utilizing Current Procedural Codes for ventral hernia repairs and myofascial muscle flaps. Following identification of patients, they were further stratified for undergoing a panniculectomy. Patients treated without the use of onlay acellular dermal matrix placement or with fewer than 6 months of follow-up time were excluded from the study. Descriptive statistics were used to summarize the findings.

Results: A total of 29 patients met the inclusion criteria, with the majority being obese (79.3%) and female (93.1%). Most patients (82.8%) had a history of previous hernia repair, with majority undergoing previous mesh placement. No hernia recurrences were observed during an average follow-up period of 21.3 months. Seromas were the most common postoperative complication (34.4%, all managed in clinic), followed by wound necrosis (20.7%) and infection (6.9%).

Conclusions: Combining VHR with panniculectomy offers potential functional, aesthetic, and quality-of-life benefits while reducing the need for multiple surgeries, particularly in patient populations with large hernia defects and prior hernia repairs. The absence of recurrences and acceptable complication rates in this study highlights the safety and efficacy of utilizing the component separation technique with onlay placement of ADM secured by progressive quilting sutures. Further research with larger, multicenter cohorts is warranted to validate these outcomes and explore strategies for optimizing complication management.